In heart failure … Role of
Loop diuretics >>>symptomatic relief .No mortality benefit
Digoxin>>> improve symptoms and reduce hospitalisation
Improve outcome >>> ACEIs , ARBs , spironolactone , ivabradine and CRT .
Saccubitril+ valsartan >>> more survival benefit than ACEIs or ARBs alone .
Spironolactone >>> with EF less than 35% and NYHA 3-4 .
Ivabradine >>> only if heart rate above 70 with BBs or if BBs are contraindicated .
ICD >>> if EF less than 35% and NYHA class 2-3 and narrow QRS
CRT-D for EF below 35% with LBBB and unexplained syncope
VVI pacemaker with pauses> 3 s and permanent AF and narrow QRS. If Paroxysmal AF>>> DDD.